Key reads

Tribes agree to settlement with distributors and J&J

Hundreds of Native American tribes agreed to a tentative settlement of $590 million with Johnson & Johnson, McKesson, Cardinal and AmerisourceBergen. Together with a deal struck last fall between the distributors and the Cherokee Nation for $75 million, the tribes will be paid a total of $665 million. The settlement is similar to the one struck with states and local governments last summer. If most tribes sign on, the deal would be notable for its size and acknowledgement of the 574 federally recognized tribes as a distinct litigating entity. The bulk of funding will be directed to addiction treatment and prevention programs, to be overseen by tribal health care experts. The deal’s timetable is far more compressed than the one agreed to with states/localities and provides funding to reflect the disproportionate impact of the crisis on tribal communities. The agreement will go forward when 95% of litigating tribes by population have agreed.

Source: Tribes Reach $590 Million Opioid Settlement With J. & J. and Distributors (New York Times)

Congress moves toward mental health and addiction legislative package

In a hearing this week, top senators on the Senate Health, Education, Labor and Pensions Committee indicated that they plan to work on a bipartisan package of legislation addressing mental health and addiction this year. Senate Finance Committee leaders began working on their own bipartisan package last fall and are expected to unveil their next steps in a February 8 hearing on youth mental health. The House Bipartisan Addiction and Mental Health Task Force released its own bipartisan package of 66 bills in September, and the House Ways and Means Committee also held its own hearing on mental health this week. The committees and witnesses at the hearings highlighted several policies related to workforce, crisis care and treatment to be included in legislation the committees plans to consider.

Source: Senate begins work on bipartisan mental health package (Roll Call)

Federal news

Biden administration working to address parity

In an opinion article, Labor Secretary Marty Walsh writes about the administration’s efforts on parity. He discusses barriers to care and his personal story of seeking care for alcohol use disorder. He explains parity and says it is a priority for the administration, the Department of Labor (DOL) and him. Last week, DOL released its report to Congress that highlights where health plans are falling short and how DOL is ramping up enforcement. DOL has increased the staff and resources dedicated to work on parity. Teams are identifying violations and working with employers and companies to increase compliance. They are also reaching out to consumers, health plans, insurance companies and state regulators to help them understand and follow the law moving forward. DOL is also working with a wide range of partners to reduce stigma.

Source: Opinion: Biden administration is making mental health parity a priority (Des Moines Register)

HHS develops standard clinical definition for opioid withdrawal in infants

The Department of Health and Human Services developed a standard clinical definition for opioid withdrawal in infants to help improve care. It is accompanied by a set of foundational principles that outlines bioethical uses for the definition. The principles center around identifying clinical and supportive care needs of mothers and their infants, using an evidence-based, compassionate and equitable approach. Lacking a standard clinical definition has created inconsistencies in diagnosing infants and has resulted in challenges around medical coding, public health surveillance, research, public health policy and program development. The new definition includes prenatal exposure and specific evidence-based clinical signs. The bioethical principles emphasize that it is not meant to prove or imply harm and should not be used to assess child social welfare risk or status.

Source: HHS Announces a Standard Clinical Definition for Opioid Withdrawal in Infants (Department of Health and Human Services)

Increasing number of overdose deaths involve para-fluorofentanyl or metonitazene

According to the Centers for Disease Control and Prevention, encounters with benzimidazole-opioids and para-fluorofentanyl are increasing in the U.S. Para-fluorofentanyl, a substance from research efforts in the 1960s and classified as a schedule I substance in 1986, has begun to reemerge on the illicit substance market. It is being found in heroin packets and counterfeit pills and reported in autopsy and toxicology results. Benzimidazole-opioids (including metonitazene), which were discovered through research for new opioid analgesics in the late 1950s but failed to receive market authorization for therapeutic use, have also begun appearing in cities across the country as adulterants in the heroin supply. Physicians, medical examiners and toxicology labs should be aware of the increased presence of these substances. Increasing public awareness and expanding naloxone availability should be prioritized.

Source: Notes from the Field: Increased Incidence of Fentanyl-Related Deaths Involving Para-fluorofentanyl or Metonitazene — Knox County, Tennessee, November 2020–August 2021 (Centers for Disease Control and Prevention)

State and local news

Most local governments sign on to settlement with distributors and J&J

About 90% of local governments nationwide that were eligible to participate in the settlement with McKesson, AmerisourceBergen, Cardinal and Johnson & Johnsons opted to do so by last week’s deadline. Those municipalities and counties are located in 45 states and several territories that had earlier agreed to settle. How much of the $26 billion settlement the companies ultimately pay depends on state and local government participation, with about $10.7 billion tied to local government participation. The companies have until Feb. 25 to decide whether enough localities signed on to proceed with the deal.

Source: Most U.S. local governments opt to join $26 bln opioid settlement (Reuters)

Maine announces agreement for distribution of opioid litigation funds

The Maine attorney general announced an agreement with cities, counties and school districts on the use of proceeds from opioid litigation. Under the agreement, 20% of proceeds will go to the state, administered by the attorney general, to address the crisis; 30% will go to the 39 counties and municipalities that filed litigation against the companies or that have more than 10,000 residents; and 50% will go to a Maine Recovery Fund that will be disbursed by a Recovery Council that will decide how best to maximize the impact of the funds on mitigating the crisis. The Recovery Council has broad discretion on how to spend the funds on opioid abatement but must allocate 3% to address abatement in special education programs.

Source: Attorney General Aaron Frey Announces Agreement for Distribution of Opioid Settlement Funds (Office of the Maine Attorney General)

Sacklers close to agreement that increases their financial contribution to the settlement

According to a new court filing, the Sacklers are “close” to an agreement that substantially increases their financial contribution to the opioid litigation settlement. The filing from Judge Shelley Chapman, who is mediating a dispute between Purdue and states that objected to its bankruptcy plan, asked for an extra week to reach a deal. U.S. Bankruptcy Judge Robert Drain extended the legal shield protecting the Sacklers from lawsuits until Feb. 17 as they try to reach a deal. Drain said allowing the shield to expire would be “quite foolish,” given the mediator’s report of a possible deal.

Source: Sacklers ‘close’ to deal to contribute additional cash in opioid settlement (ABC); Purdue Pharma judge extends Sacklers’ U.S. litigation shield to Feb 17 (Reuters)

Other news in addiction policy

Young people lost nearly 1.5 million years of life due to overdoses 2015-2019

A study found that American teens and young adults have lost nearly 1.5 million years of life due to overdoses between 2015-2019. During this time, nearly 3,300 adolescents aged 10-19 died of unintentional overdose, resulting in nearly 200,000 years of life lost. Nearly 21,700 young people aged 10-24 died from unintentional overdose 2015-2019, resulting in nearly 1.25 million years of life lost. Public health interventions and increased resources are urgently needed to prevent overdose among young people.

Source: Young Americans Lost Almost 1.5 Million Years of Life to Opioids Between 2015 and 2019 (HealthDay)

Incentives and support needed to encourage behavioral health integration with primary care

With the growing need for mental health and addiction services, integration of behavioral health services with primary care is urgently needed. To incentivize and enable primary care clinicians to take on a greater role in behavioral health care, they will need training, technical assistance and increased access to behavioral health providers for consultations and referrals. Reforming payment structures and adopting alternative payment models can help provide financial incentives for integration. To address the lack of available behavioral health providers for consultation and referral, network performance standards should be updated across payers, and increased federal funding should support consultation services. Providers must receive adequate training that prepares them for integration and prevents burnout, both through training/technical assistance and continuing education. Optimizing health information technology for behavioral health and expanding telehealth access can also help with integration.

Source: Benefits of Behavioral Health Integration for Primary Care Providers (Bipartisan Policy Center)